Michael Penston, digital transformation lead for Southampton North PCN, explains how a programmer can help shape and improve primary care services – and free up staff time
When there are so many processes and workflows in primary care, it makes sense to automate as many as possible. This frees time and helps systems run more smoothly. Practices and PCNs can achieve this by working with a programmer.
This is more localised and specific than national initiatives. NHS Digital does fantastic work, but its purpose is different. It enables interoperability and standardisation on a national level between different healthcare providers, which is crucial work. However, it does not exist to optimise the workflow of each individual organisation.
Primary care is the centre of the NHS and deals with multiple external organisations, workflows, and miscellaneous requests. Many routine tasks performed in practices should not need human input.
Registering patients, updating contact details, booking appointments and calling patients for routine reviews is important but mundane. Staff do not like doing this work, patients do not want to wait for it and GP partners would prefer not to pay for it. But there is little choice if automation is not implemented or possible.
That is where a programmer can help. People with a technical mindset can help organise, standardise, and automate these processes.
The common perception is that a programmer writes code. But before this, they’ll analyse the requirements, design the algorithms, and decide who will interact with the system.
A programmer can take an idea to make services run more effectively and put it into practice.
For example, we have effectively automated the registration system and developed a contraceptive pill check system at the University Health Service in Southampton. In terms of the pill check, one of the doctors developed a paper-based algorithm that I could develop into a usable system. It now saves 40 minutes per day of GP time.
How can practices or PCNs work with a programmer so they have maximum impact?
To be effective, a programmer needs your ideas. Without them, the programmer won’t be useful.
So, the first step is to pick a process and explain how it currently works from the perspective of patients and staff. Include information about the resources that are required and the volume you are processing. Those with an eye for operational efficiency – either a programmer or practice staff – will start spotting opportunities for automation.
An example would be what happens when a patient wants to change their address. The current process might be that the patient fills in a form or emails reception and the receptionists check if they are in the catchment area, check the address is valid, and then update the clinical system.
The questions to ask are: could this be done through an online submission? Can the address be automatically verified/selected from a dropdown? Can we automatically check if the postcode is in the catchment?
After checking these things, an email task could be sent automatically to reception, who can then finalise the update. Maybe, in a very large practice, it is worth using robotic process automation to go through and do the manual clicking. This is where software can perform manual and repetitive tasks by mimicking the actions of users interacting with the computer.
There is also a matter of access and equality. But the resources saved through automation can be used to support people without access to technology and serve more complex requests.
Should a programmer work at PCN or practice level?
Many practices would benefit from working with a programmer. It is especially true for those with unique populations, such as a student practice or one with a high proportion of patients without English as a first language, though all practices need to be adaptive to their populations and specific circumstances.
But having a full-time programmer in a practice is not necessary or the best value for money. Changes need to be implemented over time, and there is only so much programming you can do without needing a break.
PCNs with multiple practices could use someone closer to full time and share their time around the practices. Practice managers and partners would need to work very closely and suggest areas of focus.
NHS England’s funding of the digital transformation lead role through ARRS (at an 8A band, too) is a positive and bold choice. It shows a real commitment to pushing primary care to improve processes that will positively impact patient experience and practice workload.
I’ve heard of PCNs doing job shares for this, which could be a great opportunity if you have one person who is very software-focused and doing fewer hours with another who develops processes and is more present for implementation.
It’s also worth noting that there is an ongoing commitment. The system may break, the servers will need updating, and cyber security continues to evolve so maintenance will always be an unfortunate ongoing cost to automation.
What the challenges are and how they can be overcome
Automation calls for highly standardised processes. One size does not fit all, but it fits most.
Our biggest barrier is unquestionably the clinical systems because they are not designed to allow automation at all. Important patient data needs to be stored on clinical systems for record-keeping purposes and, therefore, the code written by the programmer must support the processes surrounding this.
Although it’s a challenge, programmers are technically minded and will work to get the most they can out of software and maybe even nudge suppliers in the right direction to make changes.
Programmers have a very procedural and rules-based way of thinking. Many of them will have come across several different technologies during their careers and will be aware of different approaches to automation.
At the very core of the role is understanding problems and having the power to lead change.
So, a PCN or practice hiring a programmer would need to integrate their new recruit with practices on a management level. If they can do that, having someone technical on the ground in primary care can be of enormous benefit.
Michael Penston is a student at the University of Southampton, where he studies Computer Science, as well as the digital transformation lead for Southampton North PCN.
A version of this story first appeared on our sister publication Pulse PCN.
